Prudent Eye Care Clinical Prioritisation Reconciling Risks Waits

Prudent Eye Care & Clinical Prioritisation: Reconciling Risks & Waits Graham Shortland: Medical Director Cardiff & Vale UHB Michael Austin: Consultant Ophthalmologist Abertawe Bro Morgannwg UHB

Outcomes & Accessibility • OUTCOMES – (to be achieved, with data to confirm) • Maximising • Sighted Years • Vision Related Quality of Life • Minimising • Visual impairment • Avoidable sight loss • ACCESS • To critical interventions • Timeliness

At the Coal Face… blind if not treated Age-related Macular degeneration Glaucoma Diabetic Retinopathy Cataract

At the Coal Face… blind if not treated S N O I T I D N O ESS C R N O D F N I S I L B P U BLE W SI O R Cataract Diabetic L L E Retinopathy O REV F F IR O % ING 0 9 US CA Age-related Macular degeneration Glaucoma

PREVENT UNINTENDED CONSEQUENCE e. g. stop RTT targets skewing clinical priority TOP END OF LICENSE e. g. Specialist leads Consultant oversight PAMs empowered Technicians valued EQUITY No Post Code lotteries Access based on need Right person Right place Right time TRUST COLLEAGUES TO CONTRIBUTE e. g. WECS referrals WECS postop review Nurse clinics Orthoptist injectors EMPOWER PATIENTS Respect as partners Information Education Training Support Feedback

PREVENT UNINTENDED CONSEQUENCE TRUST COLLEAGUES TO CONTRIBUTE , E N R O I A T OC A referrals e. g. stop RTT targets IS e. g. WECS T T I EWECS S postop review skewing clinical priority S R O I C Nurse. Tclinics Y C R I P A Orthoptist injectors C E D A L E P B L A A Y C T L IEQUITY ED TOP END OF LICENSE AL EMPOWER PATIENTS U Q C T I I E N I M & e. g. Specialist. Lleads No Post Code lotteries I Respect as partners L Y C L Access Consultant oversight N based on need Information E E PAMs empowered Education M GIVRight person I T Technicians valued Right place Training R Right time Support FO Feedback

Current Management of Ophthalmology System • Widespread deficit in capacity when compared with demand on services • Welsh Government’s close monitoring of new patient waiting times • Effect: • Excessively long waits for follow-up patients as a consequence of organisations prioritising new outpatients over follow-ups • c 90% of follow-ups are at risk of irreversible harm • Compared with c 10% of new referrals…

Clinical Prioritisation • New Measures project in BCU and ABMU West. • Patients no longer considered as new or follow-up, but categorised by their risk of irreversible sight loss/harm • P 1, P 2, P 3 system – to allocate priority • & given evidence-based target date to be seen

Clinical Prioritisation • P 1 – Patients who may suffer serious irreversible harm from delayed appointments • P 2 – Patients who may suffer reversible harm from delayed appointments • P 3 – Patients who may be inconvenienced or suffer mild and/ or reversible consequences from delayed appointments

Priority versus Urgency • It is important to distinguish between priority and urgency as they are not necessarily linked. • Sending Flowers on Mothers’ Day = high priority, but if 6 months away then not urgent. • Speaking to your mum on the phone when she calls to thank you for the flowers is urgent but low priority if you are currently driving…

Outcome Focussed Measures – Task and Finish Group • Chair – Dr Graham Shortland • Wide Representation – • WG, All clinician groups, Patients / 3 rd Sector • Four Meetings + homework • Literature Review • Use of Welsh Examples – Ambulance Service

“New” Patient Target Date • Patients to have a new “Patient Target Date” • New and Existing (follow-up) Patients • Regular reporting of… • % of patients waiting over their agreed target date • Over-runs expressed as proportion of intended time • Details include clinical pathways involved

Process Measures • Maximum waiting time following referral • Individual Target Date determined by clinical determination (National Condition Specific Guidance/Concensus) • Until the service is in balance this requires specific waiting time based on clinical need to define the risk if the Patient Target Date is missed • P 1 – Risk of Irreversible Harm or Significant Patient Adverse Outcome if Patient Target Date is missed • P 2 – Risk of Reversible Harm or Adverse Outcome • P 3 – No risk of Significant Harm

Process Measures (contd) • E. g. • A P 1 pathway can be any length, from weeks to months, depending on the condition and treatment requirements. • The “Purpose” of the priority code is to indicate the need to ensure that all patients are prioritised for the booking of their next appointment within the timelines specified, according to their need. • Reducing risk of harm from their condition

Timetable • September • October Agree clinical timescales Implement Patient Target Date Ophthalmic Planned Care Board to inform Performance Measures Roll-out across Wales

Any Questions ? Michael. Austin@wales. nhs. uk